# Somatic symptom severity and psychological distress among immigrants: findings from a population-based study

## TL;DR

This study finds that second-generation immigrants in Germany report higher somatic symptoms and psychological distress compared to non-immigrants.

## Contribution

The study confirms the SSS-8's measurement invariance across immigrant and non-immigrant groups and identifies higher somatic symptom severity in second-generation immigrants.

## Key findings

- The Somatic Symptom Scale-8 (SSS-8) showed measurement invariance across immigrant and non-immigrant groups.
- Second-generation immigrants reported higher somatic symptom severity compared to non-immigrants.
- Higher somatic symptom severity was associated with younger age, female gender, lower income, and higher psychological distress.

## Abstract

Somatic symptoms are frequently reported among immigrants, yet their occurrence and association with psychological distress remain understudied in population-based research using validated and measurement-invariant instruments. This study assessed the measurement invariance of the Somatic Symptom Scale-8 (SSS-8) and compared somatic symptom severity (SSS) between first- and second-generation immigrants and non-immigrants in a German population sample.

Somatic symptom severity and psychological distress were assessed using the SSS-8 and PHQ-4, respectively. Multi-group confirmatory factor analysis was conducted to test the measurement invariance of the SSS-8. Group differences were examined with ANOVA, and hierarchical regression analyses were performed to explore associations between immigration status and SSS, adjusting for distress and sociodemographic variables.

The sample included N = 6860 participants (46.8% women; M = 49.4 years, SD = 18.1), comprising n = 504 first-generation immigrants and n = 472 second-generation immigrants. The SSS-8 demonstrated measurement invariance across groups. Pain was the most frequently reported symptom. High or very high SSS was reported by 9.9% of first-generation immigrants, 12.7% of second-generation immigrants, and 7.5% of non-immigrants. In hierarchical regression models, second-generation immigrant status (ß = .15; 95% CI, 0.08–0.22; p < .001) was associated with greater SSS alongside higher age, female gender, lower income, and distress.

In this study, the SSS-8 demonstrated measurement invariance across immigrant and non-immigrant populations, supporting its applicability for research in diverse sociocultural contexts. The findings suggest a higher vulnerability to SSS and distress among second-generation immigrants, emphasizing the need for targeted screening to improve early identification and healthcare access. However, clinical studies are needed to replicate these findings.